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Introducción: el 55 % de las personas que llegan a 60 años requerirán al menos una operación, y el 50 % son urgentes, y dentro de las principales causas se encuentra la apendicitis aguda. Objetivo: conocer las características epidemiológicas y clínicas de la apendicitis aguda en el adulto mayor, con el propósito de intentar mejorar el diagnóstico y los resultados del tratamiento quirúrgico en ellos. Métodos: estudio observacional descriptivo, del tipo de serie de casos, de carácter retrospectivo, desde el 1º de enero de 2005 hasta el 31 de diciembre de 2008, en el Hospital Clinicoquirúrgico Docente "Miguel Enríquez". Se incluyeron a todos los enfermos mayores de 60 años operados de apendicitis aguda. Resultados: la incidencia de apendicitis aguda en el adulto mayor fue de 4,7 %. El grupo más afectado fue de 60 a 69 años. De los síntomas predominó el dolor abdominal y las náuseas y vómitos. El dolor típico predominó en el grupo de 60-69 años, y a medida que aumentó la edad predominó el denominado dolor atípico. Son significativas las cifras de inflamación apendicular avanzada: perforaciones (13,5 %), gangrena (13,5 %) y la supuración (21,1 %). La morbilidad global fue de 28,8 %. No existió mortalidad en esta serie. Conclusiones: la apendicitis en el adulto mayor muestra logros en términos de tratamiento y resultados en nuestra institución. Continúa con presentaciones atípicas y morbilidad significativa. Quedan acciones por realizar, en el área de diagnóstico y tratamiento quirúrgico, para lograr perfeccionar y mejorar todavía más los resultados.Introduction: the 55 % of the persons arriving to 60 years old will require at the least one operation and the 50% are urgent and within the leading causes is the acute appendicitis. Objective: to know the epidemiological and clinical features of the acute appendicitis in the elderly, to trying of improve the diagnosis and the results of surgical treatment in them. Methods: a retrospective, case series, descriptive and observational study was conducted from January,1, 2005 to December 31, 2008 in the "Miguel Enriquez" Clinical Surgical Hospital. All patients aged over 60 and operated on of acute appendicitis were included. Results: from all the symptoms there was predominance of abdominal pain, nauseas and vomiting. The typical pain predominated in the age group of 60-69 and according aging there was predominance of atypical pain. The figures of appendicular advanced inflammation: perforations (13.5 %), gangrene (13.5 %) and suppuration (21.1 %). Global morbidity was of 28.8 %. In present series there was not mortality. Conclusions: the appendicitis in elderly shows achievements in relation to treatment and results in our institution. The atypical presentations remain with a significant morbidity. It is necessary to take actions in the area of diagnosis and surgical treatment to achieve to improve still more the results.

Situs nversus totalis is a rare condition which presents difficulty in clinical diagnosis as well as laparoscopic surgery for cholelithiasis. The mirror image anatomy makes the laparoscopic intervention difficult even for an experienced surgeon. Presenting here is a case report and review of literature.

Aims and objectives: To determine the applicability of short hospital stay after appendicectomy in rural and semi-urban Nigerian community. Patients and methods : A 30-month prospective study on patients with uncomplicated acute appendicitis was carried out age ranged from 5-70years, mean of 28.7years, there was almost even sex distribution between male and female. All the patients presented with clinical evidences of acute appendicitis. Results: The operative findings were inflamed and oedematous appendix in about %, minimal exudates drained in only about 25% of the patients. Postoperative wound complications occurred in 1.3-5% of patients. All the postoperative complications were successfully managed in the outpatient clinic. 71.8% were discharged on the 2nd postoperative day, 20.5% on 3rd postoperative day, 4 (5%) on 4th postoperative day and 1(1.3%) each on 5th and 7th day. There was postoperative pain tolerance and late mobilisation in those who stayed for 3-4 days; moderately severe wound infection was responsible for those who stayed for 5th- 7th day. Conclusion: Short hospital stay after appendicectomy was possible in majority of patients with uncomplicated acute appendicitis. Minimal postoperative fluid therapy and antibiotic administration was adequate in well-selected cases.

Introduction : Single-incision laparoscopic surgery (SILS) appendectomy seeks to further minimise the trauma of parietal access of laparoscopic appendectomy. Methods: We present our initial experience of 17 cases of SILS appendectomy which were completed using conventional laparoscopic instruments. We utiliesd a single-incision multi-port laparoscopic appendectomy (SIMPLA) technique. Results: The operative time was 63 ± 20 min, blood loss 6.5 ± 5 mL, bowel movement (passing stool) occurred in 2.6 ± 0.6 days. Most patients were discharged on the first operative day on oral diet. The analgesic usage and pain scores were similar to multi-port laparoscopic appendectomy. No complications were noted at follow-up till 4 weeks and the surgical wound healed in all patients with an inconspicuous scar. Conclusion: Our initial experience with SILS appendectomy demonstrates its feasibility and supports the promise of minimising further the access of laparoscopic surgery. The clear advantage is its cosmetic benefit.

Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by mass at the base of the appendix. There have been no national recommendations or guidelines for follow-up with patients aged 40 and older after an emergency appendicectomy. The purpose of this study was to evaluate the prevalence of caecal and colonic cancer or polyps in patients over the age of 40 who have undergone an appendicectomy. This shall enable us to develop the necessary strategies to investigate and diagnose associated caecal and colonic pathology in acute appendicitis to prevent delayed diagnosis of colon cancer. Methods All patients who underwent appendicectomy between October 2011 and October 31, 2021, and who were 40 years of age or older were included in this retrospective cohort study. Patients aged 40 to 54 years old and patients 55 years or older underwent subgroup analyses. We looked at any investigations of the colon (CT pneumocolon or colonoscopy) within three years before the appendicectomy or three years after an appendicectomy. All colorectal cancers diagnosed within five years of the index episode of appendicitis were included in the analysis. Results A total of 1076 appendicectomies were performed on patients aged 40 and older during the study period of 10 years. A total of 769 patients were confirmed to have appendicitis on histology. One hundred and fifty-seven patients had colonic investigations within three years of the diagnosis of acute appendicitis. In our study, 51 of the 769 patients (6.63%) were found to have colorectal neoplasms. Eight patients (8/769, 1.04%) were diagnosed with colorectal cancers, and the occurrence of caecal cancer was 0.26% (2/769). The mortality rate was 75% (6/8) in these patients diagnosed with colorectal cancer. Four out of six died due to advanced metastatic colonic cancer. In comparison to patients aged 40 to 54, patients over the age of 55 had a statistically significant increased risk of caecal pathology (polyp and cancer) (p = 0.07). Conclusion There seems to be an increased risk of significant colorectal neoplasm in patients over the age of 55 who are admitted with acute appendicitis, and there appears to be an increased severity with a poor prognosis of cancer in these individuals. We recommend the use of routine colonoscopy or CT pneumocolon, particularly for those over the age of 55 who present with acute appendicitis or the histology of appendicular neoplasms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rajebhosale et al.)

Peritoneal inflammation without a discernible intraperitoneal source is referred to as primary peritonitis. Only 2% of pediatric acute abdominal crises are diagnosed preoperatively. Association with other infections is uncommon and is often limited to hepatic and urinary pathogens. Here, we describe a case of primary peritonitis in a one-month-old child who had laparotomy and appendicectomy as per the recommended treatment plan. There were no accompanying hepatic and urinary diseases. In this instance, methicillin-resistant Staphylococcus aureus (MRSA) was the responsible bacteria. The use of linezolid, as per the culture sensitivity report of intraperitoneal pus, ensured a smooth recovery in this case., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kumar et al.)

Background: In acute appendicitis, decision-making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross-sectional imaging. In regional settings, non-paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres., Methods: A retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length-of-stay and post-operative complication rates., Results: Four hundred and twenty-one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 10 9 , neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re-admission or complications compared with appendicectomy for appendicitis., Conclusions: Our centre's NA rate is higher than that observed in the literature at both non-paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign., (© 2023 Royal Australasian College of Surgeons.)

Objectives: To perform a systematic review on the use of magnetic resonance imaging (MRI) of the abdomen to evaluate clinically suspected appendicitis in the general adult population. We examined the diagnostic accuracy, the reported trends of MRI use, and the factors that affect the utility of MRI abdomen, including study duration and cost-benefits., Methods: We conducted a systematic literature search on PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library databases. We enrolled primary studies investigating the use of MRI in diagnosing appendicitis in the general adult population, excluding studies that predominantly reported on populations not representative of typical adult appendicitis presentations, such as those focusing on paediatric or pregnant populations., Results: Twenty-seven eligible primary studies and 6 secondary studies were included, totaling 2,044 patients from eight countries. The sensitivity and specificity of MRI for diagnosing appendicitis were 96% (95% CI: 93-97%) and 93% (95% CI: 80-98%), respectively. MRI can identify complicated appendicitis and accurately propose alternative diagnoses. The duration of MRI protocols in each primary study ranged between 2.26 and 30 minutes, and only one study used intravenous contrast agents in addition to the non-contrast sequences. Decision analysis suggests significant benefits for replacing computed tomography (CT) with MRI and a potential for cost reduction. Reported trends in MRI usage showed minimal utilisation in diagnostic settings even when MRI was available., Conclusions: MRI accurately diagnoses appendicitis in the general adult population and improves the identification of complicated appendicitis or alternative diagnoses compared to other modalities using a single, rapid investigation., (© 2023. Crown.)

ChatGPT (Chatbot Generative Pre-Trained Transformer) is an artificial intelligence with several potential applications in the field of medicine. As a large language model, it is particularly good at generating text. This study investigates the use of ChatGPT in constructing operation notes for laparoscopic appendicectomy, one of the most common surgical procedures in the UK. We prompted ChatGPT-4, the latest generation of ChatGPT, to produce operation notes for laparoscopic appendicectomy, which were then evaluated against 'Getting It Right First Time' (GIRFT) recommendations. GIRFT is an organisation that has collaborated with the National Health Service (NHS) to improve surgical documentation guidelines. Excluding certain items documented elsewhere in patient records, the generated notes were assessed against 30 key points in GIRFT recommendations. This process was repeated three times to obtain an average score. Our results showed that ChatGPT generated operation notes in seconds, with an average coverage of 78.8% (23.66 out of 30 points) of the GIRFT guidelines, surpassing average compliance with similar guidelines from the Royal College of Surgeons (RCS). However, the quality of ChatGPT's output was found to be dependent on the quality of the prompt, highlighting the need for verification of the generated content. Additionally, secure integration with electronic health records is required before ChatGPT can be adopted into the NHS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Robinson et al.)

Introduction Appendicitis is a common surgical condition that can be difficult to diagnose due to its varied clinical presentations. Surgical removal of the inflamed appendix is often necessary, and the appendix is sent for histopathological assessment to confirm the diagnosis. However, in some cases, the analysis may return a negative result for acute inflammation, known as a negative appendicectomy (NA). The definition of NA varies among experts. While negative appendicectomies are not ideal, they are accepted by surgeons to reduce the rate of perforated appendicitis, which can have severe consequences for patients. A study was conducted to investigate the rates of negative appendicectomies and their impact at a local district general hospital in Cavan, Republic of Ireland. Methods The study was conducted retrospectively from January 2014 to December 2019 on patients who were admitted with suspected appendicitis and underwent appendicectomy for appendicitis, regardless of age and sex. The researchers excluded patients who underwent elective, interval, and incidental appendicectomies. Data were collected on patient demographics, duration of symptoms prior to presentation, the intraoperative appearance of the appendix, and the histology results of the appendix specimens. Descriptive statistics and the Chi-squared test were used for data analysis with the help of IBM Statistical Package for the Social Sciences (SPSS) Version 26. Results The study retrospectively reviewed 876 patients who underwent an appendicectomy for suspected appendicitis between January 2014 and December 2019. The age distribution of patients was non-uniform, with 72% presenting before the third decade. The overall perforated appendicitis rate was 7.08%, and the overall negative appendicectomy (NA) rate was 21.3%. A subset analysis showed a statistically significant lower NA rate in females than in males. The NA rate decreased significantly over time and has been sustained since 2014 at around 10%, which is consistent with other published studies. The majority of the histology findings were uncomplicated appendicitis. Discussion This article discusses the challenges of diagnosing appendicitis and the need to reduce unnecessary surgeries. Laparoscopic appendectomy is the standard treatment, with an average cost of £2222.53 per patient in the UK. However, patients with negative appendicectomies (NA) have longer hospital stays and higher morbidity than uncomplicated cases, making it crucial to reduce unnecessary surgeries. The clinical diagnosis of appendicitis is not always straightforward, and the rate of perforated appendicitis increases with a longer duration of symptoms, particularly pain. The selective use of imaging in suspected appendicitis could reduce NA rates, but a statistical difference has not been proven. Scoring systems like the Alvarado score have limitations and cannot be relied upon alone. Retrospective studies have limitations, and biases and confounding variables must be considered. Conclusion The study found that a thorough investigation of patients, particularly with preoperative imaging, can decrease the rate of unnecessary appendectomies without increasing the rate of perforation. This could save costs and reduce harm to patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tanveer et al.)

Hemophagocytic lymphohistiocytosis or hemophagocytic syndrome is represented by an uncontrolled inflammatory response characterized by marked histiocyte activation and a cytokine storm. The entity may present a primary or genetic type, and the secondary type is usually triggered by infectious diseases of any kind, autoimmune disease, or neoplasia. This entity, although well described and with definite diagnostic criteria, still remains misdiagnosed because of the overlap presentation with other inflammatory processes. The authors present the case of a 13-year-old girl who was submitted to an appendicectomy complicated with a pericolic abscess, which required a second operation in order to be drained surgically. During the postoperative period of this second surgical procedure, the patient remained febrile, developing cytopenias, and multiple organ failure. Unfortunately, she died despite the efforts of the intensive care. The autopsy findings were characteristic of hemophagocytic syndrome. The authors report the case to call attention to this diagnosis whenever unexpected outcomes of infections are experienced.

Aim: Laparoscopic approach for complicated appendicitis (CA) is a controversial issue. Although it has been generally recommended, conflicting results have been reported in literature. The aim of this study is to obtain the current results regarding laparoscopic surgery for CA. Material and Methods: Patients who underwent surgery for acute appendicitis between July 2009 and January 2011 in Dr Sadi Konuk Training and Research Hospital were retrospectively analyzed. Appendicitis was considered as CA when there were one of the following criteria; existence of accompanying intra-abdominal abscess, peritonitis, gangrene or perforation confirmed by a histopathological examination. The patients with CA were divided into two groups, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. Demographics, perioperative findings and postoperative course were compared. Results: 846 patients with the diagnosis of appendicitis underwent surgery at our center. Of these, 124 cases were complicated appendicitis. Eighty-five (68.5%) and 39 (31.5%) patients underwent to LA and OA, respectively. The mean ages in two groups were compatible (p=0.224). The mean body mass index was significantly higher in LA group. Presence of accompanying abscess and use of intra-abdominal drain were similar in both groups (p>0.05). Duration of operation was significantly higher in LA group (76.133.7 vs 57.8 22.5) (p=0.001). Although postoperative intra-abdominal abscess formation was slightly higher in LA groups (7 cases vs 1 case), there was no difference in postoperative complication between two groups. Length of hospitalization was also not different in both groups. Time to oral feeding was significantly earlier in LA group. Conclusion: Laparoscopy in complicated appendicitis can be the first choice with no increase in postoperative complications. However, the longer operation time is still a problem for laparoscopic technique despite increasing experience. According to us, future studies should be focused on this problem. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendicectomy is one of the most commonly performed surgeries. Laparoscopic appendicectomies done under general anaesthesia are routinely associated with their own anaesthetic complications. The advent of regional anaesthesia for laparoscopic procedures to reduce complications warranted us to study the feasibility of spinal anaesthesia in laparoscopic appendicectomy in comparison with general anaesthesia. Materials and methods: This is a retrospective study which included 87 patients with a diagnosis of appendicitis, who underwent laparoscopic appendicectomies under spinal and general anaesthesia. Results: Patients in the spinal anaesthesia group had superior post-operative analgesia; however they had a longer duration of stay in the hospital as compared to the patients in the general anaesthesia group. The incidence of intra operative tachycardia and hypotension was lower in the spinal anaesthesia group. The patients in the general anaesthesia group had higher incidence of post-operative wound infection and fever. Conclusion: The observations from the study proved that laparoscopic appendicectomy is feasible under spinal anaesthesia and provides superior analgesia. The profiles of complications that may arise due to the same are not severe and can be managed easily. However, further studies with a larger sample may be warranted in order to prove the results conclusively. [ABSTRACT FROM AUTHOR]

A male child 9 years of age presented with fever, tender swelling in the right flank, with a right paramedian scar. Child had undergone exploratory laparotomy for peritonitis with appendicectomy one year back. Radiological investigations (Ultrasonography and Computed Tomography) revealed retrocecal abscess extending to the psoas muscle, which was drained via flank incision. Intermittent discharge continued through an opening in the flank just above the posterior superior iliac spine. Ultrasonography and CT fistulogram revealed a fistulous communication from skin to the cecum/appendix. Upon second exploration a fistulous communication from the tip of residual appendix (which was left in situ at the initial exploration) was found with multiple adhesions in the terminal ileum, cecum, and ascending colon. Local resection of the cecum and ascending colon was performed with ileocolic anastomosis. Fistulous tract was curetted out. Exploration confirmed the incomplete appendicectomy as a cause of this hazardous condition. [ABSTRACT FROM AUTHOR]

Background A significant proportion of general surgery emergency procedures are conducted after-hours in regional centres. The acute surgical unit (ASU) model reduces the number of after-hours operations performed. We review the burden of emergency surgery in a regional centre and assess what components of the ASU model would benefit regional hospitals. Methods Retrospective analysis was performed on data for all emergency cases performed at Latrobe Regional Hospital (LRH) over a 1-year period. Time into and out of theatre was used to determine total theatre usage and if the operation occurred after-hours. ED triage time to theatre and start time for appendicectomy was compared to data from our metropolitan referral hospital, Monash Medical Centre (MMC), which has employed an ASU. Results General surgery emergency cases in regional areas are regular and predictable with a median of two emergency cases performed, and a mean theatre time of 156 min per day at LRH. On weekdays, 43.1% ( n = 503) of emergency cases were done in the evening (18.00-24.00 hours), compared to 20.3% ( n = 217) on weekends when an emergency theatre is available during the day. LRH performed more appendicectomies after-hours than MMC over a 1-year period. Conclusion Regional centres have a significant burden of general surgery emergency procedures; of which the number performed after-hours is comparable to metropolitan centres. The number of procedures and theatre time required by these cases justify a dedicated emergency theatre in-hours similar to metropolitan ASU models and this would reduce emergency operating after-hours. [ABSTRACT FROM AUTHOR]

Acute appendicitis is a common surgical emergency. Appendix continues to be the major chunk of surgical specimens received in Pathology laboratory. However, pathogenesis of appendicitis remains poorly understood. Obstruction and inflammation is implied in pathogenesis of acute appendicitis. Presently there is increasing evidence of involvement of enteric nervous system in immune regulation and in inflammatory responses. The present study combines routine histopathology and immunohistochemistry to study the role of mast cells and enteric nervous system in pathophysiology of acute appendicitis. We have done a prospective study for a period of one and half years from January 2014 to July 2015. Appendicectomy specimens from patients who are clinically diagnosed as acute appendicitis were included in study group as cases. Appendix specimens removed at Forensic autopsies were used as controls. Study was conducted on total 138 appendix specimens of which 118 were surgically removed from patients with acute appendicitis, taken as study group. 20 specimens from Forensic autopsy, were used as comparison group (normal control group). We found a consistent increase in mast cell and neuronal counts along with prominence of ganglion cells in specimens with acute appendicitis compared to the control group. [ABSTRACT FROM AUTHOR]

Object: The aim of our study is to determine the factors that affect the delay in diagnosis of acute appendicitis, in order to decrease the morbidity and mortality of this condition. Method: The type of study is a cross sectional study, conducted for a period of one year from May 2014 to May 2015 at a tertiary care center in Karachi, Pakistan. The total study population consisted of 150 patients, the inclusion criteria was all the patients who were above 16 years of age, and presented to the emergency department with delayed presentation (two or more than two days aft er initial att ack) of acute appendicitis, and gave consent to take part in the study, the exclusion criteria was all the patients who were under 16 years of age, presented earlier than two days of signs and symptoms of acute appendicitis and those who refused to give consent. Characteristics of patients were noted in a pre designed proforma. Various characteristics of the patients were noted including age, gender, address, reason for delay, diagnosis made by the physician etc. Data was analyzed using SPSS version 23. Results: The study population consisted of 150 patients, having a mean age of 35± 12 years, of which 92 (61.33%) were males and 58 (38.66%) were females. 42 (28%) of the patients were misdiagnosed by the physicians in the emergency department on initial presentation and were referred as an outpatient case, while 50 (33.33%) of the patients were managed by non physicians on the initial att ack of appendicitis, which included homeopaths, hakeems, spiritual healers, chiropractors, nurses, and patients who self medicate, and 32 (21.33%) of the patients stayed at home, and did not seek any medical att ention in the initial two days of appendicitis. The most common reason for the delay was a lack of financial resources from the patient or the family which accounted for 43.33% of the cases. Conclusion: For the proper management of acute appendicitis it is imperative that an early diagnosis and surgical intervention be done, which significantly decreases the complications, morbidity and mortality of these patients. There is an emergent need to educate the public to seek adequate care in due time so as to avoid unnecessary complications. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the frequency of appendiceal pathology in women undergoing surgery for mucinous ovarian neoplasm and to evaluate whether appendicectomy is necessary. Methods: This single-institution retrospective study reviewed prevalence of appendiceal lesions in all patients operated on at our institution from 2002 to 2013 with the final diagnosis of mucinous tumor of the ovary. Clinicopathological data were analyzed. Results: One hundred twenty-three cases were identified. These included 45 (37%) benign mucinous ovarian neoplasms, 63 (51%) borderline, and 11 (9%) invasive mucinous ovarian tumors. In addition, 4 (3%) cases of metastatic tumors to the ovary were also identified. Appendiceal pathology was found in association with all types of mucinous ovarian tumors (benign, borderline, and malignant). In 24% of cases, appendix was macroscopically abnormal at the time of the surgery, prompting the surgical removal. Regardless of the gross findings, microscopic abnormality in the appendix was seen in 24% of all cases. The prevalence of significant occult microscopic appendiceal pathology, that is, when the appendix was grossly normal, was 6%. Conclusions: Given the prevalence of coexisting appendiceal pathology found in this study and the reported low rates of complications associated with the procedure, an appendicectomy is recommended in the management of all mucinous ovarian neoplasms. [ABSTRACT FROM AUTHOR]

Laparoscopic appendicectomy has become the preferred procedure for treating appendicitis in last 10-15 years. The reasons are laparoscopy provides a better visualization of the operating field, pelvic organs like ovaries can be visualized in female patients, causes less postoperative pain, needs lesser hospital stay, gives faster recovery and most importantly a better cosmetic scar. The standard laparoscopic appendicectomy needs 3 ports to be introduced into the abdomen. Many modifications were introduced recently like SILS (Single port/Incision Laparoscopic Surgery), NOTES (Natural Orifice Transluminal Endoscopic Surgery), TUSPLA (Trans Umbilical Single Port Laparoscopic Appendicectomy), etc. with an intention to decrease the postoperative pain, decrease the hospital stay and give better cosmetic outcome. We present a series of twelve cases of laparoscopic appendicectomy performed using two ports and a needle instead of third port, which when performed successfully gives a better cosmetic outcome as the third port is avoided. Aims and objectives: The aim of the study was to assess the feasibility of two ports needle assisted laparoscopic appendicectomy. Materials and methods: This was an observational study done on a total number of 42 laparoscopic appendicectomies performed by a single operating team between June 2015 and May 2016. Two port appendicectomy were attempted. But, the procedure could be successfully performed in only 12 cases because of various reasons. Results: Out of 42 cases TPNAA could be performed successfully in 12 procedures. 30 cases needed regular 3 port procedure because of various reasons. Conclusion: TPNAA is a modification of regular three port appendicectomy and is a simple procedure and gives a better cosmetic outcome which can be performed in selected cases. [ABSTRACT FROM AUTHOR]

Purpose: To examine the presentation, investigation, histological diagnosis and outcome of patients who underwent acute appendicectomy in children aged 5 years and under. Methods: This is a retrospective case note review of all children aged 5 years and under who underwent emergency appendicectomy at our institution over a two-year period. Results: Two hundreds and seventy-two patients underwent emergency appendicectomy for a clinical diagnosis of appendicitis. Twenty-three patients were 5 years of age or less (8%) with 11 boys and 12 girls. Three had perforated appendicitis (13%), 13 had non-perforated appendicitis (57%). Six had normal appendicectomies (26%), of which 2 had Meckel's Diverticulitis (9%) and 1 had enter-obius vermicularis infestation (4%) Twenty patients had bloodsampling for inflammatory makers(87%). Ultrasound was performed in 8 cases (35%). One patient had an intra-abdominal collection post perforated appendicitis (4%) and one patient had an incisional hernia (4%). Conclusion: Accurate diagnosis of acute appendicitis in this age group remains challenging. Adjuncts to clinical assessment are frequently employed but their accuracy remains poor. The relative low incidence of acute appendicitis in very young children means that it is often overlooked. A high index of suspicion may aid earlier diagnosis and thereby reduce morbidity and length of hospital stay. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the usefulness and feasibility of the Alvarado scoring system in acute surgery in reducing the percentage of negative appendicectomy in our institute. Materials and Methods: A prospective study was conducted, comprising 100 patients, admitted to department of Surgery in Maharishi Markendeshwar Institute of Medical sciences & Research (M.M.I.M.S.R), Mullana, Ambala, India during the period October 2012 to July 2014 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into three groups: group1 (alv. Score >7), group 2 (alv. score 5-6), group 3 (alv. Score <4). The signs, symptoms, laboratory values, surgical interventions, and pathology reports of each patient were evaluated. Diagnosis was confirmed by histopathological examination. Sensitivity, specificity, and positive and negative predictive values of scoring system were calculated. Results: Out of 100 cases (82 males, 18 females), 76 Patients belonged to be in group1 (76%), 20 patients were in group 2 (20%) and 4 patients were in group 3 (4%). All 100 patients were operated, of which 86 patients found to have inflamed appendix (86%). 82 (82%) of operated patients were male and 18 (18%) were females. Out of 82 of operated males, 64 were having score > 7, 8 were having score 5-6 and 1 had score <4. Out of 18 operated females, 6 were having score > 7, 4 were having score 5-6, and 2 females had scoring <4. Negative appendectomy rate in our study was 14% which showed that Alvarado score helped in making diagnosis of acute appendicitis; thus reducing negative appendicectomy. Sensitivity and specificity of the Alvarado scoring system were found to be 83.7% and 71% respectively. Positive and negative predictive values were 94.7% and 83.3% respectively. Conclusion: Alvarado score can be used effectively in acute surgery in our setup to reduce the incidence of negative appendectomies in both male and females. It can be applied easily for acute surgery even by junior surgical colleagues with limited diagnostic facilities available to them.ry even by junior surgical colleagues with limited diagnostic facilities available to them. [ABSTRACT FROM AUTHOR]

Objective: Objective of this study is to present our experience by harmonic scalpel enabled, single external port appendicectomy using extracorporeally inserted ′pick and fix′ stitch in three cases. Materials and Methods: Of the eighteen appendicectomies performed with only the use of harmonic scalpel in the last 11 months, the last three were performed using a single external port with the second port accessed under the subcutaneous tissues. The procedure consists of anchoring the mesoappendix to anterior abdominal wall by an extracorporeally inserted ′pick and fix′ stitch followed by dissection and division of mesoappendix and appendix only with harmonic scalpel. Results: There were three patients, one female and two males aged 5, 7, and 11 years, respectively. Two were elective and one was emergency appendicectomy. Mean operating time was 30 min without any surgical complications. All patients are in follow-up with no complications. Conclusion: This study demonstrates the combined virtue of single external port, use of harmonic scalpel, and ′pick and fix′ suture in laparoscopic appendicectomy in children. This approach avoids the use of an additional port as well as endosuture; and is safe, efficient, cost-effective, and is associated with reduced surgical time.

BACKGROUND: Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is scant. This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis. MATERIALS AND METHODS: The study group consisted of two hundred and seventy nine patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendicectomy (LA) and one hundred seventy nine patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost in terms of their medians. The Mann-Whitney statistics (T) were calculated and because of large samples, the normal deviate test (Z) was used. RESULTS: Of the hundred patients, six patients (6%) had the procedure converted to open surgery. The rate of infections and overall complications (LA: 15%, OA: 31.8%, P < 0.001) were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA, 5 days after OA, P < 0.0001) than after OA. The operating time was shorter {OA: 25 min (median), LA: 28 min (median), 0.01< P < 0.05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. CONCLUSION: Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same. LA is also associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Background De Garengeot hernia is defined as femoral hernia containing appendix. An acute appendicitis in a femoral hernia is a extremely unusual surgical finding and occurs in 0.08%–0.013% of all cases. Case report We report the case of an elderly woman, who presented with a typical clinical image of incarcerated femoral hernia and underwent open surgery. An infrainguinal incision was performed and after the dissection of hernia sac, an acute appendicitis within femoral hernia was revealed. Subsequently, appendectomy and hernioplasty were performed. Conclusion Acute appendicitis within femoral hernia should be included in differential diagnosis of patients presenting with clinical signs of an incarcerated femoral hernia and prompt surgical treatment is essential in order to avoid severe complications. [ABSTRACT FROM AUTHOR]

Appendiceal neoplasms are uncommon and found in 1.6 per cent of appendicectomy specimens. Schwannomas arising from the appendix are of significant rarity, with only a few previously‐reported cases. In this study, we present the case of a 31‐year‐old man who underwent a laparoscopic appendicectomy and was found to have an appendiceal schwannoma. In the present study, we review the literature of this rare condition, which serves to highlight the potential for appendiceal neoplasia to occur in a macroscopically‐normal appendix. Furthermore, it emphasizes the potential risk of missed appendiceal neoplasia as a sequelae of nonoperative management of suspected appendicitis. [ABSTRACT FROM AUTHOR]

The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. It is an uncommon and rare condition estimated to be found in approximately 1 % of hernia. However, in just 0.08 %, the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix, and is most often misdiagnosed as an incarcerated inguinal hernia. As such, it is rarely recognized prior to surgical exploration. We report a case of Amyand’s hernia in a 2-month-old male, who presented as a right-sided congenital hernia with pain in the right groin. He underwent herniotomy, which revealed that the hernia sac containing elongated inflamed appendix appeared with some adhesions to sac, lying in the inguinal canal.

Acute appendicitis is very uncommon in the first year of life and often its presentation is atypical with high risk of complications. Hereby, we present 4 clinical cases of infants, who were diagnosed with acute appendicitis in our hospital over the last year. The reported clinical cases highlight the several drawbacks clinicians face when managing infants with symptoms suggestive for acute appendicitis. After specific diagnostic work-up, even if not conclusive, patients were intraoperatively diagnosed with acute appendicitis and underwent appendicectomy. Maintaining a high index of suspicion for acute appendicitis in infants presenting with intra-abdominal sepsis of unclear etiology is, in our opinion, the most crucial factor to avoid complications and longer hospitalization. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous inflammation is a well-described entity with involvement of various body organs. But the involvement of vermiform appendix in the disease process is quite rare with only few cases are reported in literature. This case report describes a 50-year-old man, who was diagnosed as a case of acute appendicitis with appendicular lump on the basis of clinical history, physical examination, and hematological and radiological investigations. Patient underwent surgical interventions twice. But, he succumbed to the disease. We are reporting this case in view of rarity of the disease and the fulminant course, which has not been described in any other reports.

Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP) approach using Polypropylene Mesh (Mesh) and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

Background: This updated systematic review and meta-analysis investigates the putative role of the appendix in ulcerative colitis as a therapeutic target., Methods: Ovid Medline, Embase, PubMed and CENTRAL were searched with MeSH terms ("appendectomy" OR "appendicitis" OR "appendix") AND ("colitis, ulcerative") through October 2020, producing 1469 references. Thirty studies, including 118 733 patients, were included for qualitative synthesis and 11 for quantitative synthesis. Subgroup analysis was performed on timing of appendicectomy. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs)., Results: Appendicectomy before UC diagnosis reduces the risk of future colectomy (OR, 0.76; 95% CI, 0.65-0.89; I2 = 5%; P = .0009). Corresponding increased risk of colorectal cancer and high-grade dysplasia are identified (OR, 2.27; 95% CI, 1.11-4.66; P = .02). Significance is lost when appendicectomy is performed after disease onset. Appendicectomy does not affect hospital admission rates (OR, 0.87; 95% CI, 0.68-1.12; I2 = 93%; P = .27), steroid use (OR, 1.08; 95% CI, 0.78-1.49; I2 = 36%; P = .64), immunomodulator use (OR, 1.04; 95% CI, 0.76-1.42; I2 = 19%; P = .79), or biological therapy use (OR, 0.76; 95% CI, 0.44-1.30; I2 = 0%; P = .32). Disease extent and risk of proximal progression are unaffected by appendicectomy. The majority (71% to 100%) of patients with refractory UC avoid colectomy following therapeutic appendicectomy at 3-year follow-up., Conclusions: Prior appendicectomy reduces risk of future colectomy. A reciprocal increased risk of CRC/HGD may be due to prolonged exposure to subclinical colonic inflammation. The results warrant further research, as consideration may be put toward incorporating a history of appendicectomy into IBD surveillance guidelines. A potential role for therapeutic appendicectomy in refractory left-sided UC is also identified., (© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Appendicitis is a global disease with an incidence of 7-12% in the population of the USA and Europe but is low and rising in the developing world. It is the most common acute general surgical emergency, but as no investigation is accurate, the diagnosis has to rely on clinical symptoms and signs and, thus, frequently misdiagnosed. The aim of the study was to debate the arguments for managing appendicitis (operative, nonoperative, or both)., Patients and Methods: Electronic searches of the MEDLINE (PubMed) database, Cochrane Library, and Science Citation Index were performed to identify original published studies on appendicitis and the pre-COVID-19 (coronavirus disease 2019) and post-COVID-19 management. Relevant articles were searched from relevant chapters in specialized texts, and all have been included., Discussion: There are indications for operative (surgery), nonoperative (antibiotics), or both in the management of acute appendicitis. Although laparoscopic appendicectomy is becoming the gold standard of treatment, knowledge of the pros and cons of this approach versus the open approach is important. The controversy in the management of the appendix mass/abscess between an expedient appendicectomy or a combination of conservative management (antibiotics) and interval appendicectomy remains., Conclusion: Laparoscopic appendicectomy is becoming the gold standard for the treatment of appendicitis. However, the advantages of the innovations in minimally invasive and endoscopic surgery are unlikely to render formal open appendicectomy obsolete. Nonoperative management with antibiotics may suffice in selected cases with uncomplicated appendicitis. It is imperative that patients are counseled appropriately if primary antibiotic treatment is to be routinely offered as first-line therapy., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Acute appendicitis represents one of the common causes of admission to the emergency department. In rare cases, patients with appendicitis can suffer complications such as intestinal obstruction. These particular cases of occlusive appendicitis with a periappendicular abscess usually occur in elderly patients and can develop in an aggressive form, nonetheless with a favorable evolution. We present a case of an 80-year-old male patient, reporting symptoms similar to an occlusive digestive pathology: abdominal pain, intestinal transit disorders, and fecal vomiting. A computerized tomography scan suggested a mechanical bowel obstruction. The patient had an exploratory laparotomy indication to find the cause of the obstruction. The peritoneal cavity inspection revealed an occlusive form of acute gangrenous appendicitis with a periappendicular abscess. An appendectomy was performed. In conclusion, as surgeons, we must always take into consideration that acute appendicitis can represent a cause of intestinal obstruction, especially in elderly patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Najm et al.)

Background: The most common general surgical emergency operations are laparoscopic appendicectomy, laparoscopic cholecystectomy, hernia repair, hemorrhoidectomy and colectomy. Patients commonly perform an internet search for more information prior to undergoing surgery, which can lead to an inappropriate understanding of their procedure. The aim is to assess the quality of information available on three of the most used search engines., Methods: A search was conducted on Google.com, Bing.com and Yahoo.com using the terms related to laparoscopic appendicectomy, laparoscopic cholecystectomy, hemorrhoidectomy, hernia repair and colectomy. First 20 results from each search engine were collected for evaluation. Results were excluded if they were sponsored, duplicates, academic publications, advertisements, forums, audiovisual tools, social media or any non-English information. Included results were assessed for reliability using DISCERN and JAMA benchmark score. Readability was assessed using Flesch Reading Ease (FRE) Score and Simple Measure of Gobbledygook (SMOG)., Results: Hundred and ninety-seven websites were analysed, 44.7% were published by institutions, 34.5% by health websites and 20.8% by independent surgeons. Mean DISCERN scores for Institutions was 54.6 ± 11.3, independent surgeons 45.9 ± 11.4 and health websites 58.7 ± 10.3. Mean JAMA score for Institutions was 1.0 ± 1.0, independent surgeons 0.1 ± 0.4 and health websites 1.7 ± 1.1. FRE scores for institutions was 51.6 ± 10.3, independent surgeons 40.9 ± 10.2, and health websites 45.7 ± 12.3. SMOG scores were 9.8 ± 1.5 for institutions, 11.4 ± 1.6 for independent surgeons and 10.6 ± 1.7 for health websites., Conclusion: Health information on common general surgical procedures found on search engines are generally fair to good quality but still above the suggested reading level of the population. Information on surgical procedures should be written at recommended reading level of 13-14 years old., (© 2023 Royal Australasian College of Surgeons.)

The diagnosis of appendicitis is based on clinical picture. The aim of this retrospective study was to analyse variation of outcomes and impact of increasing use of radiological investigations and laparoscopy over a 5-year period. A retrospective audit of appendicectomies over the last 5 years (01 January 2007-31 December 2011) was conducted. The negative appendicectomy rate (NAR), perforation rate and complication rate were used as outcome endpoints. A statistical analysis was performed to evaluate the difference in outcomes with surgical approach and use of radiology. One thousand fifty-five appendicectomies were performed in this period. The NAR was 22.65 % (21 % for open and 28 % for laparoscopic) and perforation rate was 14 %. There was no statistically significant difference in NAR with the use of ultrasound ( P 0.3814) but there was a significant reduction in NAR with the use of computed tomography (CT) ( P <0.0001). Intra-abdominal abscess (2.3 %) and wound infection (1.4 %) were the common complications with the former being higher with laparoscopy and the latter with open appendicectomy. Over 5 years, there were no significant changes in appendicectomy outcomes. The impact of diagnostic imaging on NAR varies with age, gender and the use of CT. CT can significantly reduce the negative appendicectomy rate in equivocal presentations. Complication rates vary with surgical approach. [ABSTRACT FROM AUTHOR]

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: for patients undergoing appendicectomy for complicated acute appendicitis is simple ligation or invagination of the appendix-stump safer? Using the reported search, 587 papers were found. Five studies were deemed to be suitable to answer the question. In conclusion, the literature is more in favour of the appendix stump being managed with simple ligation rather than stump invagination. All 5 studies assessed are prospective, randomised studies, though overall the quality of these studies is poor. The outcomes assessed were incidence of post-operative complications (pyrexia, wound infection, abscess, caecal fistula and post-operative ileus), post-operative length of stay and mean operating time. The analysis indicates no significant difference between the groups in rates of post-operative pyrexia, intra-abdominal abscess or caecal fistula. Only one study showed a significant difference in rates of wound infection in favour of simple ligation. One study demonstrated a significant difference in favour of simple ligation when comparing rates of post-operative ileus. Overall, simple ligation was found to reduce patient length of stay when compared with stump invagination; one study found this difference to be significant. Simple ligation also produced shorter operating times compared with stump invagination--a risk factor for the development of post-operative ileus. All studies suffered limitations that make the quality of the evidence assessed poor. Although this evidence does favour simple ligation of the stump as compared to invagination, higher quality randomised studies are needed to answer the question definitively. [ABSTRACT FROM AUTHOR]

Aim This study aims to compare the outcomes, morbidity and hospital stay in patients who underwent emergency surgery, and those who underwent percutaneous drainage for treatment of appendicular abscess. Patients and methods From April 2013 to October 2014, we recruited 40 patients with appendicular abscesses for this study. These patients were randomized into two groups: group 1 (20 patients) for emergency surgery and group 2 (20 patients) for percutaneous drainage. Preoperative data, hospital stay, functional recovery and postoperative complications were analyzed. Results Functional recovery was 2.2 ± 1 days in group 1 and 1 ± 0 day in group 2. Hospital stay in group 1 was 7.7 ± 3.5 days and in group 2 was 4 ± 1 days. Postoperative complications in group 1 were noted in 8 (40%) patients. No complications were recorded in group 2. Conclusions Appendicular abscesses may be safely and effectively treated by US-guided percutaneous drainage with high technical and clinical success rates, low incidence of complications and shorter hospital stay. [ABSTRACT FROM AUTHOR]

Acute appendicitis is the most common cause of acute abdomen requiring immediate surgical treatment. Although many patients have received the benefits of the videolaparoscopic appendicectomy, there are controversies regarding its systematic use in this disease. To achieve this, a literature review was carried out in which some updated elements on this technique are exposed, which, given its diagnostic and therapeutic usefulness, is progressively occupying its place as election procedure in any phase during the morbid process. All these justifies the necessity of deepening in the main cognitive aspects related to this topic, because this is the way to rise the assistance quality in hospitals and, with that premise, to have uniform performance protocols that will benefit those who present this frequent disease. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is a disease of the young presenting in children and early adolescents although no age group is exempt. It is the most common cause of acute surgical abdomen worldwide. This clinicopathological study aims to determine the various lesions of the surgically removed appendix in our centre and if any, changing trend in this lesion in our environment. Method: A retrospective study was undertaken to review the histopathology reports of all appendicectomy specimens submitted to the Department of Pathology of the Asokoro District Hospital, Abuja; Nigeria from November 2009 to October 2012 Patient's biodata, clinical signs and symptoms were extracted from the request form. Result: A total of 293 appendices were received during the 3-year study period constituting about 10% of total specimens. The male to female ratio was 1:1.3 with a mean age of 26.33 ± 11.39 years. Acute appendicitis was found in 81.2% of our cases while other lesions constitute 14.7% and negative appendectomy occurred in 4.1% of the cases. No mortality was recorded. Conclusion: The findings in this study compared favourably with those of our environment and in the developed world although acute appendicitis in this study showed slight female preponderance. [ABSTRACT FROM AUTHOR]

Background Studies evaluating mortality in patients with acute appendicitis focus on the outcomes of appendicectomy alone. We hypothesize this may not be representative of what happens in clinical practice as a small proportion of patients with acute appendicitis undergo procedures other than appendicectomy, for example, caecectomy or right hemicolectomy. To clarify the issue, the authors evaluated Australian adult patients who died with a primary diagnosis of acute appendicitis regardless of whether they underwent an operation or the type of operation performed. Methods A cross-sectional analysis of systematically collected mortality data from the Australian and New Zealand Audit of Surgical Mortality was conducted on adults who died in hospital with a primary diagnosis of acute appendicitis between January 2009 and December 2012. Results Twenty-six patients died with a primary diagnosis of acute appendicitis. The median age was 83 years and the median number of co-morbidities was three. Four patients died without surgery due to their family's wishes. Twenty-two patients were treated surgically: five for right hemicolectomy, four for laparoscopic/ Mc Burney appendicectomy, 10 for laparotomy with appendicectomy, two for unknown method of appendicectomy and one for open abscess drainage. Conclusion Most adult patients who died following surgery for acute appendicitis did not undergo simple appendicectomy but underwent more complicated procedures for complex appendicitis. [ABSTRACT FROM AUTHOR]

Background and Objective: Appendicectomy for acute appendicitis is one of the most commonly performed surgical procedures. Acute appendicitis has remained a clinical entity and an ongoing diagnostic challenge. A retrospective study was performed to determine histological diagnosis, demographic data, the rate of perforated appendicitis and negative appendicectomies. Methods: Histopathological records of 480 resected appendices submitted to histopathology department at Arar Central Hospital in the Northern Border Province of Saudi Arabia over the period of 3 years from July 2011 to June 2014 were reviewed retrospectively, to determine acute appendicitis, complication (gangrene, perforation) rate, negative appendicectomy rate, histopathological diagnosis and unusual finding on histology. Results: Out of 480 specimens of appendix, appendicitis accounted for 466 (97.0%) with peak occurrence in the age group of 11 to 50 years in male and 11 to 40 years in female. Histopathological diagnosis include acute appendicitis 250 (52.0%), suppurative appendicitis 135 (28.0%) acute gangrenous appendicitis 60 (12.5%), perforated appendicitis 9 (2.0%), chronic appendicitis 12 (2.5%). Negative appendicectomy rate was 14 (3%) and two time more common in female with peak occurrence in the age group of 20-30 yrs. There was no unusual histological finding like carcinoid tumour of appendix. Conclusion: The present study showed a high number of appendicitis in adolescents and young adults. Negative appendectomy was more common in females. The study support routine histological examination of all the appendicectomy specimens to avoid missing of any clinically important and treatable condition. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre. However understanding of hospital factors that influence time-to-theatre (TTT) is poor. Thus, the aim of this study is to identify factors that influence TTT and to observe the effect of prolonged TTT on patient outcome. Methods: A retrospective review of an electronic prospectively maintained database was performed over a 2 year period. Factors thought to influence TTT were highlighted. A delay was defined as TTT >8 hours. Data analysis was performed using SPSS 20. Results: 1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7%. 68.1% underwent laparoscopic appendicectomy. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between delayed TTT and female gender (p = 0.017), older age (p = 0.001), pre-operative radiology (<0.001), normal WCC (p < 0.001), normal neutrophils (p < 0.001) and histological non-perforated appendix (p< 0.001). However, on multivariate analysis, younger age, a neutrophilia and presence of a perforation had a shorter TTT. Delayed TTT did not affect outcome variables including post-operative collection (3.59% v 4.38%, p = 0.528), readmission rate (6.54% v 5.72%, p = 0.403) and length of stay (3.1 days v 3.34 days, p = 0.823). Conclusions: This study highlights key hospital factors that influence TTT in patients with suspected appendicitis. Identification of these influential factors adds greatly to our understanding of patient prioritisation. Finally, TTT delays greater than 8 hour do not appear to affect short-term patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction Acute appendicitis is a common surgical diagnosis. We investigated the use of blood markers (WCC, CRP and serum bilirubin) and diagnostic imaging (USS and CT scan) to arrive at this diagnosis, as well as the surgical approach used for appendicectomy. Methods This was a retrospective analysis of consecutive patients undergoing appendicectomy in seven hospitals within GG&C Health Board during a 6 month study period. Data were collected from electronic patient records. Sensitivity and specificity of each investigation for diagnosing acute appendicitis was calculated. Results 363 patients were included. Appendicectomy was performed open in 53%, laparoscopically in 43% and converted in 4%. Diagnostic imaging was used in 38%. The overall negative appendicectomy rate was 15% (18% when no imaging was used, 23% when USS was used and 1% when CT scanning was used). Elevated bilirubin had a sensitivity of 0.44 and a specificity of 0.84 for detecting acute appendicitis. Sensitivity and specificity for elevated WCC were 0.78 and 0.55, and for elevated CRP were 0.81 and 0.59, respectively. The specificity of bilirubin for diagnosing perforated appendicitis was 0.63. Discussion WCC and CRP were sensitive blood markers in acute appendicitis, whereas serum bilirubin was more specific. Diagnostic imaging with a CT scan was very effective at reducing the rate of negative appendicectomy, but USS was not. Conclusion Serum bilirubin has utility in diagnosing acute appendicitis, irrespective of whether perforation has occurred. CT scanning should be considered the first line imaging modality for investigation of acute appendicitis if diagnosis is in doubt. [ABSTRACT FROM AUTHOR]

Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We have presented here our experience using spinal anesthesia as the first choice for laparoscopic surgery for over 2 years with the contention that it is a good alternative to general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Convincing arguments for either removing or leaving in-situ a macroscopically normal appendix have been made, but rely on surgeons' accurate intra-operative assessment of the appendix. This study aimed to determine the inter-rater reliability between surgeons and pathologists from a large, multicentre cohort of patients undergoing appendicectomy.Materials and Methods: The Multicentre Appendicectomy Audit recruited consecutive patients undergoing emergency appendicectomy during April and May 2012 from 95 centres. The primary endpoint was agreement between surgeon and pathologist and secondary endpoints were predictors of this disagreement.Results: The final study included 3138 patients with a documented pathological specimen. When surgeons assessed an appendix as normal (n = 496), histopathological assessment revealed pathology in a substantial proportion (n = 138, 27.8%). Where surgeons assessed the appendix as being inflamed (n = 2642), subsequent pathological assessment revealed a normal appendix in 254 (9.6%). There was overall disagreement in 392 cases (12.5%), leading to only moderate reliability (Kappa 0.571). The grade of surgeon had no significant impact on disagreement following clinically normal appendicectomy. Females were at the highest risk of false positives and false negatives and pre-operative computed tomography was associated with increased false positives.Conclusions: This multi-centre study suggests that surgeons' judgements of the intra-operative macroscopic appearance of the appendix is inaccurate and does not improve with seniority and therefore supports removal at the time of surgery. [ABSTRACT FROM AUTHOR]